By vgreene, 28 May, 2015 If nonadherent w/ abnl TSH: consider weekly oral administration of full week’s dose [W/L]
By vgreene, 28 May, 2015 If perceived allergy/intolerance to levothyroxine: change dose/product<sup>24</sup>
By vgreene, 28 May, 2015 If sx persist<sup>23</sup> despite normal TSH: acknowledge sx, eval for alternative causes [W/L]. Follow sx (cold sensitivity, dry skin, fatigue, ↑ wt, puffiness, constipation, etc), but sx alone lack sensitivity/specificity [W/L]
By vgreene, 28 May, 2015 Normalize TSH,<sup>19,20</sup> avoid iatrogenic thyrotoxicosis (esp. in elderly) [S/M]
By vgreene, 28 May, 2015 Adjust dose if large wt Δ, pregnancy, aging; ✓ TSH 4-6 wks post dose change [S/M]. If dose higher than expected, eval/tx GI disorders<sup>21</sup>
By vgreene, 28 May, 2015 If obesity/depression/dyslipidemia/athyreosis:<sup>22</sup> insufficient evidence of benefit to recommend aiming for low-NL TSH or high-NL T3 levels [S/M]<sup>19</sup>
By vgreene, 28 May, 2015 Re-✓ TSH if change in product<sup>21</sup> (brand or generic) [W/L], or if start/stop estrogen or androgen; or if start TKIs, phenobarbital, phenytoin, carbamazepine, rifampin, sertraline [S/L]
By vgreene, 28 May, 2015 NL TSH range higher in older pts (eg, >65 yo); higher TSH targets may be appropriate [S/L], esp. if >80 yo. Target TSH of 4–6 in pts >70–80 yo
